微导管成袢技术在颅内动脉瘤栓塞治疗中的应用  

Application of microcatheter loop technique in embolization of intracranial aneurysms

作　　者：郭锋[1] 孟凡国[1] 于建军[1] 蔡菁[1] 孙爱刚[1] 郇林春[1] 姜除寒[2] 

机构地区：[1]临沂市人民医院神经外科,山东276003 [2]首都医科大学附属北京天坛医院神经介入科

出　　处：《中华神经外科杂志》2015年第5期465-469,共5页Chinese Journal of Neurosurgery

摘　　要：目的 总结微导管成袢技术治疗颅内动脉瘤的技术要点,评价其可行性及安全性.方法 回顾性分析19例采用微导管成袢技术治疗的颅内动脉瘤.根据动脉瘤的位置及载瘤动脉特点选择不同成袢方式,窄颈动脉瘤单纯弹簧圈栓塞,宽颈及巨大动脉瘤应用支架结合弹簧圈栓塞.结果 18例患者利用成袢技术使微导管顺利到位,16例行血管内成袢,目标血管为大脑中动脉M2段4例,大脑前动脉A1段4例,后交通动脉5例,小脑后下动脉2例,脉络膜前动脉1例.2例行瘤内成袢.12例置入Solitaire支架,6例单纯行弹簧圈栓塞,术后均恢复良好,无成袢相关并发症.1例大脑中动脉瘤行瘤内成袢时未成功,发生动脉瘤破裂出血,术后死亡.结论 成袢技术可使微导管进入常规技术难以进入的锐角血管,提高动脉瘤栓塞治疗的成功率,但存在诱发动脉瘤破裂的风险,瘤内成袢禁用于已破裂动脉瘤的治疗.Objectives To summarize the technical points of the microcatheter loop technique for the treatment of intracranial aneurysms and to evaluate its feasibility and safety.Methods Nineteen patients with intracranial aneurysms treated with the microcatheter loop technique were analyzed retrospectively.Different loop techniques were selected according the locations of aneurysms and the anatomical features of the parent arteries.The narrow-necked aneurysms were embolized with simple coils and the wide-neck aneurysms and giant aneurysms were embolized with stents and coils.Results Using the loop technique,18 patients made the microcatheters into place smoothly,16 performed intravascular loop.The target vessels of 4 patients were the M2 segment of middle cerebral artery,4 were the A1 segment of anterior cerebral artery,5 were posterior communicating artery,2 were posterior inferior cerebellar artery,and 1 was anterior choroidal artery.Two patients performed intra-aneurysm loop,and they were all middle cerebral aneurysms.Solitaire stents were implanted in 12 patients,6 underwent coil embolization alone.They recovered well after surgery.No loop-related complications were observed.One patient with middle cerebral artery aneurysm died after procedure because his intra-aneurysm loop failed and the aneurysm ruptured.Conclusions Microcatheter loop technique induces microcatheters into acute vessels that conventional techniques are difficult to access.It improves the success rate of aneurysm embolization;however,it has the risk of inducing aneurysm rupture.Intra-aneurysm loop is forbidden for the treatment of ruptured aneurysms.

关 键 词：颅内动脉瘤 血管内技术 栓塞治疗 

分 类 号：R651.12[医药卫生—外科学]